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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013416767
Report Date: 04/03/2023
Date Signed: 04/03/2023 12:17:53 PM

Document Has Been Signed on 04/03/2023 12:17 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:HARVEST CHRISTIAN PRESCHOOL/DAYCAREFACILITY NUMBER:
013416767
ADMINISTRATOR:DISLA DE PEREZ, JUANAFACILITY TYPE:
850
ADDRESS:4360 HANSEN AVENUETELEPHONE:
(510) 713-8748
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 98TOTAL ENROLLED CHILDREN: 27CENSUS: 23DATE:
04/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Juana Disla De PerezTIME COMPLETED:
12:25 PM
NARRATIVE
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On April 3, 2023 at approximately 11:00am Licensing Program Analyst (LPA) Russ Haderer arrived unannounced to review lead testing re-test that still failed. LPA met with site director Ms. Juana Disla De Perez to discuss the nature of the visit. There were 23 children in care (all preschool age) with 3 fingerprint and associated staff present. The center is in ratio today.

On December 14, 2022 the sampling vendor pulled the water samples, however, made an error and was required to pull new tests on December 28, 2022. Samples were drawn for 10 water locations in the facility. Lab results analyzed found that locations A in classroom 2 and C in classroom 3 showed lead levels to be 10.9ppb and 6.5ppb (respectively). Values greater than 5.5 ppb is deemed an Action Level Exceedance and requires the issuance of a deficiency and a Plan of Correction. The other 8 locations tested were less than 5.5ppb and/or ND - non-detected. Faucets A and C have not been in use, are labeled with appropriate do not use signage. Children bring their own bottled water from home and if needed, they are provided with Britta filtered water from the kitchen faucet that passed lead level testing. The facility does not prepare or cook food.

The faucets were replace and retested on March 9, 2023. The sampling vendor retested all outlets again (not just those with ALE) and found high lead levels in faucets that passed on December 28, 2022. Due to a question of confidence of the findings, the center will shut down all faucets for water consumption and open a contract with a bottled water service for all water to be consumer by children.

A Type B deficiency and plan of correction has documented and issued today, see LIC809D. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the site director Juana Disla da Perez.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/03/2023 12:17 PM - It Cannot Be Edited


Created By: Russell Haderer On 04/03/2023 at 12:06 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HARVEST CHRISTIAN PRESCHOOL/DAYCARE
FACILITY NUMBER: 013416767

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/10/2023
Section Cited
CCR
101238(a)

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101238 Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
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Facility will permanently shut down all water fountains in the building and close the angle stops, and contract with a bottled water service to provide water for all water to be consumed by children.
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Based on lead testing (retesting) results, 3 of 4 faucets re- tested have lead levels exceeding 5.5ppb which poses a potential Health and Safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Chandra Charles
LICENSING EVALUATOR NAME:Russell Haderer
LICENSING EVALUATOR SIGNATURE:
DATE: 04/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/03/2023


LIC809 (FAS) - (06/04)
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